Sarrell Dental Seen Filling The Gap For The Poor in Alabama

Three years after recession took hold of the nation, Alabama has had a hard time dealing with the consequences. A report released last week details 10 statistics illustrating that consequences may be even more difficult for the state’s children.

The worsening statistics, including infant mortality rate, the number of low-birthweight babies, teen death rate, rising rates of child poverty and single-parent families, are affected by the economy, because many are problems associated with poverty.

According to the 2011 Kids Count data report released by the Annie E. Casey Foundation, one in four Alabama children was living in poverty in 2009. Poverty is defined as income below $21,756 for a family of four. That statistic represents a 19 percent increase over 2000 and is 25 percent higher than the national average.

The economy isn’t solely to blame for the problem. Back in 2000, before the recession hit, Alabama had a poverty rate nearly 25 percent higher than the national average. Poverty is an issue for the entire Southeast. The Kids Count report assigns rankings to the states determined by each state’s 10 statistics. Southeastern states dominate the bottom of the rankings. North Carolina, Tennessee, Kentucky, Georgia, West Virginia, South Carolina, Arkansas, Alabama, Louisiana and Mississippi all ranked between 38 and 50.

The only non-Southeastern states in the bottom 13 were Nevada, which came in at 40, Oklahoma, 43, and New Mexico, 46. The states rank so low because of the regionally high poverty rate, said Laura Speer, associate director of policy reform and data for the Casey Foundation.

“This is because children who grow up in households with incomes below the poverty level are more likely to experience a host of bad outcomes in areas from physical and emotional health to education and the list goes on,” she said.

So, in areas where poverty is more common, such as in the Southeast, more children are affected, pushing up many of the indicators.

But poverty isn’t just about jobs. According to Alabama Arise communications director Jim Carnes, poverty is a multi-dimensional challenge.

“The poor performance on measures like this and Kids Count across the South just reflects the long history of injustice,” he said.

The entire region suffers because of institutionalized racism beginning with slavery, which kept a good deal of its population trapped in poverty and unable to contribute to the well-being of the region, he said. That history of inequality has become part of the structure of the South in general and in Alabama in particular, Carnes said.

The poverty rate is one statistic that Alabama Senate President Pro Tem Del Marsh, R-Anniston, said he and the Legislature are working to improve.

“Obviously, the best way we can alleviate this is to create more jobs,” he said.

The Legislature will focus on encouraging job creation and expansion in existing businesses through tax credits, and by easing some regulations that he thinks stifle growth, Marsh said, adding that it’s quicker and more efficient to encourage growth of existing businesses than to try to lure new ones.

“We all like new business,” he said. “But the fact of the matter is if you look at most statistics, it’s the existing businesses that employ and continue to employ more people.”

State-specific issues

In Alabama, that institutional injustice is manifested in things like poor funding of schools, which helps keep the poor from bettering themselves, unequal access to health care and a regressive tax system, which taxes the state’s lower earners at nearly twice the rates paid by higher earners, Carnes said.

“It’s a problem that sort of feeds on itself because if we’re failing to provide any pathways out of poverty, then how can we expect children to perform better each year or be healthier each year?” Carnes asked. “We have to see how all this fits together and that policies matter.”

The policymakers, though, are dealing with unprecedented deficits. They are being forced to make cuts while at the same time seeing increased needs. It’s a tough problem to deal with, and they are pulled in many different directions. Marsh, for instance, has heard Alabama Arise’s ideas, but he doesn’t believe the state’s tax system is punitive, and he said he also knows his constituency.

“Alabama Arise is a group that is always unhappy with the tax structure of Alabama,” he said. “They particularly want to see more emphasis put on the property tax. But we talked about it; we polled it, and I don’t see the people of the state of Alabama moving toward a property tax base.”

Education issues

Alabama did make some improvements, according to the Casey Foundation report. Its child death rate decreased 15 percent and the teen birth rate decreased 13 percent. One improvement that could have far-reaching effects for the state is a decrease in high school dropouts.

In the last decade, from 2000 to 2009, the state has cut the percentage of 16- to 19-year-olds not in school and not holding a high school diploma nearly in half, from 13 percent to 7 percent.

“That’s part of the accountability piece that is something positive about No Child Left Behind, that we are focused on the number of students we start with and the number of students who are successful program completers,” said Anniston City Schools Superintendent Joan Frazier.

For the individual student, that high school diploma means choices, Frazier said.

“It gives them a list of options instead of just a narrow field,” she said.

National statistics reflect those options, even in the recession.

According to a report released in March by the Alliance for Excellent Education, the national unemployment rate among individuals without a high school diploma was three times higher than the rate of those with a bachelor’s degree or higher in January 2011.

Successfully graduating high school students also benefits the community and the state. It means those students will have the opportunity to be productive in ways that would not be open to them otherwise, and that can mean big economic gains to the state.

That same report from the alliance lists some of those gains for Alabama. The report estimated that if half of the state’s 24,300 high school dropouts had graduated with their diplomas in 2010, those graduates would have earned an additional $118 million over an average year. They would have spent an additional $89 million and invested an additional $29 million. By the midpoint in their careers, these students would probably purchase homes totaling $227 million more than they could have purchased without their diploma and spent an additional $13 million on vehicles in a single year.

Their increased spending would have created as many as 800 new jobs across the state, and the state would have collected an additional $6.6 million in taxes from the income and spending in an average year.

But just as important is what the state is not paying out, said Jeff Gagne, policy director for Southern Regional Education Board.

“If they’re contributing, they get a diploma and get a better-paying job, they’re less likely to be relying on services that the state or the fed would have to provide,” Gagne said. “So, there’s a double value here.”

But education has suffered cuts as the economic doldrums have dragged on. Through proration, the Anniston City Schools system, for instance, has lost about $1 million in state funding in the last three years, an average of 7 percent to 11 percent each year, and every school system in the state has suffered the same kinds of losses.

Marsh said the Legislature is committed to spending wisely when it comes to education and has protected some proven educational programs and intends to invest in others, such as charter schools, but everything is on the table.

“It’s not just a matter of throwing money at education,” he said. “It’s putting money in the right programs. That’s what we’re going to focus on is getting money in the right areas of education.”

Smart spending is good, said Carnes, but the starvation of the system is just exacerbating the problem.

“It’s not an abstract thing to say we have to reduce the budget,” he said. “That has a human toll, and we have to be mindful of that human toll, and this report is a good reminder of the consequences that we’ll face if we continue to take that single-minded approach of cutting.”

Health care issues

Even as education can help to improve the future of the state, there are things the state could be doing right now that would have a dramatic effect quickly, Carnes said, citing health initiatives as an example.

Poverty can have a dramatic affect on a child’s health, according to Anniston pediatrician Dr. Carla Thomas.

“If you’re in poverty, a lot of times you don’t have proper nutrition,” she said. “You don’t have the ability to access the health care delivery system in a timely fashion that allows you to get effective and efficient care.”

In Alabama, Sarrell Dental and Eye Centers is one of the providers trying to fill that gap for the poor. Brandi Parris, chief marketing officer for the nonprofit group, said while many dental practices are seeing declines in business in the poor economy, the Sarrell Centers are seeing a rapid increase in visits at its clinics around the state. The clinics specialize in providing low-cost dental and eye care to children receiving Medicaid.

“We just had our 26th consecutive quarter of record patient growth, which definitely shows there’s tons more people on Medicaid having to utilize these services,” Parris said. “We’re up as of right now, year to date, up 40 percent on patient visits.”

Parris projects the centers will have more than 100,000 visits by the end of the calendar year. Last year, the centers had more than 80,000 patient visits. She quotes from a report that children on Medicaid are 38 times more likely to be denied dental care than those on other insurance programs.

But the cycle of poverty affects children even before they are born.

“We have lots of social supports for children in Alabama,” Thomas said. “It’s rare that I see a child who is a U.S. citizen who doesn’t have some sort of health insurance either through Medicaid or through the other programs that are available.”

However, adults ages 21 to 64 are not as well-covered, Thomas noted. That could be one reason infant mortality rates and the number of low-birthweight babies are increasing. Those statistics reflect a lack of access to adult care, she said, and low-birthweight babies can suffer problems later in life as a consequence — educational issues for instance.

That’s another reason, Carnes said, Alabama Arise suggests investment in health initiatives as a way to counteract the effects of poverty. Obesity and diabetes are major problems in Alabama and are closely linked with poverty.

“It’s related to the limited dietary options that people face at low income levels,” he said. “We need to think about that as a society.”

One thing the state might do to help combat the problem is to make physical education a mandatory class in all schools, Carnes said. Another option is healthy diet education, he said. Society has to make human-centered policy decisions, he said.

Frazier, the Anniston schools chief, put it another way. Although Alabama’s schools have been making strides, it’s never good enough until 100 percent of students are successful.

“I kind of equate it to the number of air flights that are in the air every day, which is somewhere between 3,000 and 4,000,” she said. “If you had less than 100 percent of those successful, we would not be satisfied.”